7 Best Exercises and Stretches for Piriformis Syndrome

What is Piriformis Syndrome?

Piriformis Syndrome occurs when the Piriformis Muscle becomes overly tight and begins to compress or pinch on the Sciatic nerve. The compression of the nerve causes inflammation within the nerve and it results in the onset of a deep, dull, central gluteal (buttock) pain, which may or may not be accompanied by numbness and tingling down the back of the thigh.

The Piriformis muscle is a flat, narrow muscle that helps to perform hip external rotation (think of when you point your knee out to one side away from you). In 80% of people, the Sciatic nerve exits the hip by passing just below the Piriformis muscle, however, in a select number of people the Sciatic nerve pierces directly through the muscle.

Either way, if the Piriformis muscle and other hip external rotator muscles become overly tight, they will eventually begin to compress on the Sciatic nerve causing Piriformis Syndrome type symptoms.

What Causes Piriformis Syndrome?

Piriformis Syndrome can be caused by any activity that causes increased tightness of the hip and gluteal muscles that leads to compression of the Sciatic nerve.

The most common causes of Piriformis Syndrome are:

• Repetitive hip motion activities that cause excessive tightness of the hip muscles over time (for example: long-distance running, hiking, etc.)
• Sitting for long periods of time (for example: sitting for several hours at work)
• Long periods of inactivity cause the hip muscles to get tight
• Falling onto the buttocks
• Strenuous lifting that strains the Piriformis muscle
• Climbing stairs, walking, squatting, and/or running with weak hip muscles
• Exercising without proper warm-up and cool-down stretching

How is Piriformis Syndrome Diagnosed?

• Self-reports of a deep, dull, central buttock/gluteal pain
• Numbness and/or tingling from the buttock down the back side of the thigh
• Tenderness to palpation of the Sciatic nerve near the central part of the buttock/gluteals
• Pain with sustained sitting, standing, running, or lying activities

Piriformis Syndrome can sometimes be mistaken as Hip Bursitis, however, Hip Bursitis causes pain in the far, outer hip area whereas Piriformis Syndrome causes pain near the deep, central buttock area.

Activities to Avoid

If you begin to experience symptoms that you feel may be coming from Piriformis Syndrome, it is important to stay away from activities that would further aggravate the Sciatic nerve.

Activities to avoid for Piriformis Syndrome include:

• Activities that may increase the tightness of the hip and gluteal muscles (for example: long-distance running, walking, hiking, going up/down several flights of stairs, repetitive squatting, etc.)
• Activities that would cause direct compression to the Sciatic nerve located in the buttock region (for example: sitting for long periods of time while at work or while traveling)

Piriformis Syndrome Treatment Options

There are several treatment options available for Piriformis Syndrome. A conservative treatment approach should be able to relieve Piriformis Syndrome symptoms within 2-4 weeks of starting treatment as long as you remove the aggravating activities. Even with daily treatments, if you continue to perform the aggravating activities, the Piriformis muscle will remain tight and the Sciatic nerve will continue to cause pain in the buttock and leg.

Piriformis Syndrome treatment options include:

• Soft Tissue Massage
  • Massage of the glutes and hip external rotator muscles can help relieve muscle tightness resulting in decreased Sciatic nerve compression.
• Stretching
  • Daily stretching of the glutes and hip external rotator muscles can relieve muscle tightness.
• Heating Pad
  • A heating pad and/or a whirlpool bath can all help relieve muscle tightness.

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• NSAIDs
  • Non-Steroidal Anti-Inflammatory Drugs (Advil, Aleve, etc.) may help reduce Piriformis Syndrome symptoms as they help by reducing Sciatic nerve inflammation (which is what causes the pain). Be sure to speak with your doctor before taking any medications, though, to ensure that it is safe for you to take.
• Voltaren Topical Gel (Diclofenac Sodium)
  • Voltaren Gel is a topical gel that is sold over the counter at your local drugstore or even on Amazon. It’s a non-steroidal anti-inflammatory gel that you can rub onto the painful body part multiple times per day. It’s a transdermal gel that soaks through the skin and acts to reduce the pain and inflammation of the structures only in the area that it is rubbed onto. Be sure to speak with your doctor before taking any medications, though, to ensure that it is safe for you to take.

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• Muscle Relaxer Medications
  • Prescription medications such as Cyclobenzaprine and Flexeril can provide chemical relaxation of the tight muscles.
• Sciatica Pressure Relief Pillow
  • Sciatica pillows are expertly molded to provide pressure relief of the Sciatic nerve when sitting. These are really comfortable and can be used at work, in the car, or at home. My favorite Sciatica pressure relief pillow is the Cushion Lab Pressure Relief Pillow.

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• Corticosteroid Injections
  • A Corticosteroid is a powerful anti-inflammatory. A specialized doctor can provide a corticosteroid injection near the Sciatic nerve, which can help reduce pain and inflammation.
• Physical Therapy
  • Formal physical therapy may be required if the Piriformis Syndrome symptoms have not responded regardless of your self-treatment attempts.

Piriformis Syndrome Exercises to Avoid

There are only two exercises that one should avoid, at least in the beginning treatment phases, when dealing with Piriformis Syndrome.

Piriformis Syndrome exercises to avoid include:

• Clamshells (a.k.a clams)
  • The clamshells exercise challenges the Piriformis muscle as well as the other hip external rotator muscles. Strengthening this muscle will only cause increased tightness of these muscles leading to increased Sciatic nerve irritation.

  

• Aggressive stretching of the Piriformis muscle and other hip external rotator muscles
  • Aggressive stretching of these muscles will only cause increased compression of the Sciatic nerve. One should only perform GENTLE stretching of these muscles until the Piriformis Syndrome symptoms begin to decrease in severity, then increased stretching intensity can be allowed.

How Can I Prevent Piriformis Syndrome?

To prevent the onset of Piriformis Syndrome, consider some of the following suggestions:

• Use a sit-to-stand desk at work to prevent sustained compression while sitting on the Sciatic nerve.
• Exercise regularly and strengthen the glute complex muscles.
• Stretch the hip muscles routinely.
• Perform a proper warm-up and cool-down prior to exercising.
• Use proper lifting techniques when squatting and lifting repetitively. 

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